The overall objective of the proposed research is to provide a mechanism for upgrading the performance of emergency medical technicians (EMT's) and thereby to improve the quality of prehospital care for victims of emergency accidents and illnesses. Clinical algorithms will be used for performance assessment and will be developed by a phased process. A cardiac algorithm will serve as a model for initial development, testing, and validation; subsequently other clinical algorithms will be analyzed to yield a compliance score. During the final phase, analyses will be conducted to identify relationships between selected background and experiential characteristics and EMT performance. Algorithm compliance data will also be used in the development of refresher training. Alternative refresher training approaches will be tested by analyzing changes in EMT performance over time, and the approach which yields the greatest impact on performance will be identified.